PET/CT imaging

Clinical case - Triple vessel coronary disease

   
 
     
  Who we are  
 
 
  Professor Juhani Knuuti
Director of Turku PET Centre


Doctor Sami Kajander
Radiologist at Turku PET Centre


Turku PET Centre
Turku, Finland


As a Finnish National Research Institute, Turku PET Centre led by Professor J. Knuuti, promotes the use of PET in the medical research field. The Centre was founded in 1974 by the University of Turku, Åbo Akademi University and the Turku University Hospital. The Centre integrates top scientific expertise with excellent facilities and equipments. Fruitful interaction and collaboration between basic scientists and clinical investigators is a long-standing tradition.

The latest imaging technology is available, some unique in Europe. The Centre provides several tracers for routine and research clinical imaging in Oncology, Neurology and Cardiology, using the Europe's first 64 slices PET/CT system. With its excellent cyclotron and radiochemistry laboratories, Turku PET Centre develops and produces the latest PET tracers for clinical imaging.

 
  Turku Medical Cyclotron Project  
     
  Patient History  
 
 
 

Male – 67 years old

 
 

Risk factors family history: Hypercholesterolemia
Couple of months ago stable exercise associated angina that has been getting gradually somewhat more severe. Practices quite much exercise in daily life. Recently, CCS II-III symptoms. Exercise capacity normal but after severe chest pain with st-depressions

 
     
     
  Acquisition  
 
 
 

Scanner: GE Discovery VCT

 
     
  PET acquisition: REST & STRESS acquisitions  
 
2D acquisition using VUE Point targeted reconstruction
4 min40 in concurrent dynamic mode
Adenosine stress perfusion followed by rest perfusion
1000 MBq of Oxygen-15 each for rest and stress.
 
     
  CT acquisition: Cardiac SnapShot Pulse  
 
Rotation speed: 0.35 second
Slice thickness: 0.625 mm
kVp: 120 · mA: ECG modulated 250–600 mA
 
     
  Contrast injection parameters: Two phases injection  
 
60 - 80 ml of iodine contrast at 4.0 – 4.5 ml/sec
60 - 80 ml of saline flush at 4.0 – 4.5 ml/sec
Iodine concentration: 400 mg/ml.
 
     
     
  Findings  
 
 
 
       
Hybrid PET/CT image displaying relative myocardial stress perfusion
 
Hybrid PET/CT image displaying absolute myocardial stress perfusion  
Hybrid PET/CT image displaying relative myocardial stress perfusion   Hybrid PET/CT image displaying absolute myocardial stress perfusion  
       
CT curved image displaying the overall plaque burden on the LAD      
CT curved image displaying the overall plaque burden on the LAD  
 
 
 

CT Findings:

 
 

Severe ruptured plaque in left main stem. LAD and LCX distal calcified plaques but not clear stenosis. Distally in the left vessels no significant stenoses.

 
 

RCA calcified plaques and significant distal stenosis.

 
     
 

PET Findings:

 
 

Myocardial relative stress perfusion was homogenous (left image) but absolute perfusion measured as ml/g/min was very low in all myocardial regions (1.0-1.3 ml/g/min). Perfusion was analyzed using CARIMAS Turku software.

 
 

Two days later coronary bypass operation LITA-LAD and AO-LPL.

 
     
     
  Conclusion  
 
 
 

This case shows that quantification of myocardial perfusion in absolute terms gives important additional information. In this case with balanced three-vessel coronary disease analysis of relative perfusion failed to detect any abnormalities. However, severe reduction in all vessel regions were detected in quantitative assessment of myocardial perfusion.

 
 

 

 
 
 
   
   
   
   
   
   
     
Who we are  
Patient History  
Acquisition  
Findings  
Conclusion  
     
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  Partial / Absolute